Predicting Eczema in Infants : Breakthrough Skin Biomarker Research

In 2022, it was estimated that a staggering 223 million individuals worldwide were grappling with the challenging skin condition known as atopic dermatitis, or eczema. Among them, a noteworthy 43 million were young children aged between 1 and 4, making it a particularly prevalent issue in early childhood.⁽¹⁾

Alarmingly, approximately 60% of those afflicted with atopic dermatitis experience its onset within their first year of life.⁽²⁾ This statistic underscores the critical need for early detection and intervention to alleviate suffering and improve long-term outcomes.

In a groundbreaking development, researchers from the esteemed institution National Jewish Health have made a remarkable discovery. They have identified specific biomarkers present on the skin that hold the potential to predict whether a baby is at risk of developing eczema, even months before the actual onset of symptoms. This revelation marks a significant leap forward in our understanding of the condition, potentially revolutionizing how we approach its diagnosis and treatment.⁽³⁾

This breakthrough holds immense promise for the future of eczema management. By pinpointing these predictive biomarkers, scientists are paving the way for the development of precisely targeted therapies. This personalized approach has the potential to greatly enhance the effectiveness of treatment, offering hope to millions of individuals grappling with this chronic and often debilitating condition.

The findings of this pivotal study have been recently published in the esteemed Journal of Allergy and Clinical Immunology, signifying a major milestone in the field of dermatology and pediatric medicine.⁽⁴⁾ As further research and clinical applications unfold, we can anticipate a brighter future for those affected by atopic dermatitis.

Before we carry on further, though, let us look at what exactly is atopic dermatitis. 

Atopic dermatitis, commonly known as eczema, is a chronic inflammatory skin condition characterized by a range of uncomfortable symptoms. It affects millions worldwide and can significantly impact one’s quality of life.

Several factors contribute to the development and exacerbation of eczema. A significant influencer is genetics, with a family history of atopic dermatitis or major allergies playing a pivotal role.⁽⁵⁾ Additionally, an overactive immune system is often implicated in its onset. Environmental irritants, such as air pollution, smoke, harsh cleansers, and certain fabrics, can further aggravate the condition.^(6,7,8,9)

Eczema manifests through a variety of general symptoms, commonly referred to as flare-ups. These include dry, scaly skin, redness, persistent itching, the presence of a skin rash, raised bumps, and potential swelling. In infants, it typically begins with dry and itchy skin on the scalp and cheeks.

As a child grows older, eczema may manifest in various areas of the body, including the outer or creased regions of the knees and elbows, around the mouth, on the hands and feet, wrists and ankles, and even the outer areas of the ears.

Triggers for eczema flare-ups are diverse and can vary from person to person. These may include factors like heightened stress levels, dry weather conditions, exposure to allergens like dust and pollen, irritating fabrics, soaps, or detergents, pollutants, food allergies, and even certain cosmetics or skincare products.^(10,11,12)

Regrettably, at present, there is no definitive cure for atopic dermatitis. However, medical professionals employ various treatment strategies to manage its symptoms. These often involve the use of medications, including topical corticosteroids and antihistamines, to alleviate discomfort and reduce inflammation. In some cases, phototherapy may also be recommended as an effective treatment option.^(13,14)

With ongoing research and advancements in dermatology, there is hope for more targeted and effective treatments in the future. In the meantime, early detection, trigger avoidance, and consistent medical management remain crucial for individuals living with eczema. 

The research team emphasized the critical need for a reliable method to predict the likelihood of an infant developing atopic dermatitis, underscoring that not every infant is affected, with just about 20 percent experiencing the onset of this condition. Therefore, it becomes paramount to identify this specific subset of infants predisposed to atopic dermatitis, enabling a targeted approach to treatment.

The researchers articulated a fundamental aspiration in the field, that is, the possible prevention of atopic dermatitis. So while treatments can provide relief, the condition tends to recur, making prevention one of the primary focus. By understanding the predictive biomarkers identified in the study, researchers are poised to delve into strategies aimed at averting the onset of atopic dermatitis, a potentially transformative approach in dermatological care.

In a collaborative effort, the research team at National Jewish Health partnered with scientists from South Korea to embark on a pioneering study centered on predicting the development of atopic dermatitis in infants.

To gather crucial data, doctors in the study employed a non-invasive skin tape method to procure samples of skin cells from infants at the tender age of two months, a stage when no clinical indications of eczema were present. Notably, this diverse sample pool included infants both with and without a family history of atopic dermatitis.

Over the course of two years, these infants were meticulously observed and monitored, allowing for the collection of additional skin cell samples at specific intervals. This comprehensive approach facilitated a thorough examination of the progression of atopic dermatitis in these young subjects.

At the end of the study, the research team reported a significant finding. Among the 74 infants identified as being at risk, 22 ultimately developed atopic dermatitis. Upon meticulous analysis of their skin cells, scientists pinpointed two specific skin biomarkers: thymic stromal lymphopoietin (TSLP) and interleukin‐13 (IL-13).^(15,16) These biomarkers exhibited a remarkable 75 percent increase in infants who subsequently went on to develop atopic dermatitis.

The team stressed on the significance of these discoveries, highlighting that IL-13 and TSLP are molecules known to promote allergic responses. The abnormal presence of these biomarkers in the skin of atopic dermatitis patients serves as a crucial predictive factor, signifying a predisposition to the condition. Moreover, treatments designed to counteract the activity of IL-13 and TSLP could, therefore, hold immense promise in preventing the onset of atopic dermatitis, potentially revolutionizing its management and offering hope to countless individuals affected by this challenging skin condition. 

This groundbreaking findings suggest that skin irregularities manifest prior to the visible onset of a skin rash. This crucial insight can open the door for many other proactive measures to be taken before the appearance of the actual clinical symptoms, potentially offering a significant breakthrough in atopic dermatitis prevention.

In order to introduce an effective preventative therapy, healthcare professionals must identify the skin abnormalities before patients display visible signs of a rash. With the discovery of the biomarkers IL-13 and TSLP, there arises a newfound avenue for preventing eczema through the application of targeted therapies, such as emollients or other biologics. ^(17,18) The genesis of the disease appears to be rooted in a compromised skin barrier that allows allergens to penetrate through. A deficient skin barrier leaves a patient vulnerable to environmental hazards, driving the onset of atopic dermatitis.

Looking ahead, the research team is now delving into the next phase of their research, spurred by the observation that the allergic pathway is already activated as early as two months of age. This prompts the investigation into what exactly triggered this pathway prior to that age. They aim to trace this pathway back to its origins, seeking to unravel when and how the allergic response was initially set in motion. The team is even looking into the possibility of this activation occurring in utero, a potential revelation that could reshape their approach to preventing allergic diseases.

There is no doubt that the study illuminates the potential for early immune and barrier biomarkers, identified through the innovative tape stripping technique, to predict which children are predisposed to developing atopic dermatitis in the future. This introduces a groundbreaking concept – that of the potential for early prevention of atopic dermatitis in susceptible children. The study’s findings represent a significant stride forward in our understanding and management of this challenging skin condition. 

The research team from National Jewish Health along with an international team of researchers have achieved a major breakthrough in the fight against eczema. Their discovery of specific skin biomarkers, IL-13 and TSLP, provides a potential means of predicting eczema in infants before visible symptoms emerge. This opens the door to targeted preventative measures and a potentially revolutionary shift in eczema treatment strategies.

By identifying skin irregularities prior to clinical symptoms, the study lays the foundation for proactive interventions that could significantly reduce the burden of eczema for affected individuals and their families. The early activation of the allergic pathway at just two months of age also prompts further investigation into critical factors influencing eczema development. This research offers hope for a future where preventative measures can be employed at an early stage, potentially sparing countless children and families the challenges posed by this chronic skin condition.

References: